Preventing and Treating Pediatric Migraines


May 22, 2018 by: Roy Benaroch, MD Article Tags: ,

Parents are sometimes surprised to find out that migraines are the most common cause of recurrent headaches in children. Yes, kids get migraines – and many adults who get them started getting them as children, even if they weren’t diagnosed correctly.

(Side note: many adults who get migraines are still not being diagnosed correctly. Do you get “sinus” headaches? They’re almost certainly migraines. Yes, I know you feel congested with them. Yes, I know you know they’re in your sinuses. But they’re not. They’re migraines, and have nothing to do with your sinuses. But I’m getting off topic here, and I’m not your doctor, so feel free to just disregard this paragraph.)

Dealing with pediatric migraines starts with making the right diagnosis – which is usually easy, if you listen to the patient and ask a few of the right questions. A brief physical exam can confirm that there’s nothing else to worry about, and advanced imaging like CTs or MRIs is almost never needed. Once there’s a history of over a few months of recurrent headaches, a clinical exam will tell you everything you need to know.

Prevention is the key. Migraines are really uncomfortable and disruptive, and an ounce of prevention is worth much more than a pound of cure. Many pediatric migraines are triggered by things like hunger, lack of sleep, disrupted schedules, dehydration, and many other lifestyle habits. Stress is almost always another contributor. Remember: stress for a child includes not just worry, but also strong positive emotions, like excitement. Stress isn’t just related to things a child doesn’t like. Families and kids can learn to identify and avoid some of their own triggers, leading to far fewer migraines.

In adults, daily medications are commonly used as preventives. A recent study from the New England Journal looked at two common migraine preventers in children – topiramate (AKA Topamax) and amitriptyline.  The good news is that both medications did decrease the frequency of headaches – but the bad news is, neither was any better than the placebo group. That’s right: whether the study participants (all children and teens) took either of the drugs or a placebo pill, they all reported a decrease in headaches. Score one for sugar pills! Both the amitriptyline and topiramate groups experienced side effects, so the study was stopped early.

There’s some evidence for the effectiveness of a few less-traditional agents to prevent migraines in adults. These might help in children, too. Vitamin B2, taken daily, seemed to work better than a placebo, and at least small trials of a few other generally safe agents like magnesium and butterbur show promise. Even if they’re not much better than a placebo, they’re safer than most medications.

We do have very good “abortive” agents to treat migraines once they begin. These include non-steroidal OTC meds like ibuprofen or naproxen, or prescription medications called “triptans”. All of these work best if taken very soon after any migraine symptoms start. But all of these are also prone to causing “rebound headaches” if taken too frequently. So, again, prevention is better than cure. (Still, a cure is nice to have if you need one!) By the way, narcotic medications should never be used to treat migraines, especially in children – they increase the sensitivity of the pain system, and can increase pain after even short-term use. 

If your child has recurrent headaches, start by keeping a log to track potential triggers and causes. Don’t discount the role of stress, even if your child “doesn’t seem stressed.” And try to encourage good, regular sleep and eating habits. Still having headaches? It’s time to see the doctor. Even if daily medications don’t show much promise, we’ve got other good options to both prevent and treat migraines in children. 

Roy Benaroch

Roy Benaroch, MD

Roy Benaroch, MD, FAAP is an Associate Adjunct Professor of Pediatrics with Emory University. He has produced several courses exploring medical cases for laymen in his "Medical School for Everyone" lectures, available from The Great Courses, and has also written books for parents and chapters in medical textbooks. He is also on the Board of Directors of The Children's Care Network, one of the largest clinically integrated pediatric care networks in the country. Dr. Benaroch practices general pediatrics near Atlanta, GA.